Provider Demographics
NPI:1568896272
Name:SALUD INTEGRAL LA MONTANA
Entity Type:Organization
Organization Name:SALUD INTEGRAL LA MONTANA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAN SOCIAL WORKER
Authorized Official - Prefix:MS
Authorized Official - First Name:MILEINY
Authorized Official - Middle Name:
Authorized Official - Last Name:RIVERA SOTO
Authorized Official - Suffix:
Authorized Official - Credentials:TSC
Authorized Official - Phone:787-612-1416
Mailing Address - Street 1:HC 74 BOX 5936
Mailing Address - Street 2:
Mailing Address - City:NARANJITO
Mailing Address - State:PR
Mailing Address - Zip Code:00719-7431
Mailing Address - Country:US
Mailing Address - Phone:787-612-1416
Mailing Address - Fax:
Practice Address - Street 1:HC 74 BOX 5936
Practice Address - Street 2:
Practice Address - City:NARANJITO
Practice Address - State:PR
Practice Address - Zip Code:00719-7431
Practice Address - Country:US
Practice Address - Phone:787-612-1416
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-08-29
Last Update Date:2013-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR20201261QF0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)